Senior Compliance Auditor

Job Summary Are you passionate about ensuring compliance in healthcare? Join our team as a Senior Compliance Auditor, where your expertise will play a crucial role in safeguarding our health plans against regulatory and contractual discrepancies. Your work will be instrumental in identifying and managing compliance risks, ultimately upholding the integrity and safety of Molina Healthcare. Essential Job Duties Lead and execute comprehensive pre-delegation and annual audits to ensure all regulatory and accreditation standards are met. Conduct detailed examinations of delegate policies, procedures, and case files to confirm quality service delivery. Collaborate with delegate leadership to assess risks and develop effective solutions. Utilize your analytical skills to pinpoint systemic issues and work with other departments to address and minimize risks. Analyze audit results to identify root causes and formulate corrective action plans (CAPs). Prepare and oversee audit findings, ensuring accurate reporting that meets departmental standards. Present audit findings and reports to relevant committees and leadership, offering recommendations for improvements. Collaborate with oversight leadership to refine and enhance assessment tools. Make independent decisions on complex issues and project components. Serve as a subject matter expert on applicable policies, regulations, and contracts. Stay updated on all regulatory and accreditation standards, interpreting changes and their potential impacts. Engage in outreach efforts to communicate key performance indicators (KPIs) with department leadership. Provide training and support for new and existing team members in delegation oversight. Required Qualifications A minimum of 3 years of experience in managed care, including at least 2 years focused on delegation oversight auditing, or an equivalent combination of education and experience. Ability to work independently and collaboratively within a team, managing multiple projects simultaneously. Strong collaboration skills to thrive in a highly matrixed organization. Detail-oriented with exceptional organizational abilities. Excellent critical thinking and problem-solving skills. Outstanding interpersonal and communication skills, both written and verbal. Proficient in Microsoft Office Suite, especially Excel, and adaptable to new software. Preferred Qualifications Hold certifications such as Certified Credentialing Specialist (CCS), Licensed Practical Nurse (LPN), Licensed Vocational Nurse (LVN), Certified Clinical Coder (CCD), Certified Medical Audit Specialists (CMAS), Certified Professional in Healthcare Management (CPHM), or other relevant healthcare certifications. All licenses must be active and unrestricted in the respective practice state. Molina Healthcare is proud to be an Equal Opportunity Employer (EOE) M/F/D/V. We offer a competitive benefits and compensation package. Pay Range: $80,168 - $128,519 annually (actual compensation may vary based on geographic location, work experience, education, and skill level).

Created: 2026-03-04